About six years ago I didn’t know what a “pelvic floor” was. I didn’t understand it’s function, importance, or where it was located on the human body. Today, I preach to all my female clients how it’s essential to have a full functioning pelvic floor, especially after giving birth.
To begin, we should look at the anatomy of the pelvic floor and get an idea what’s what.
As you can see, the pelvic floor is a series of small muscles. Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. The pelvic organs are the bladder and bowel in men, and bladder, bowel, and uterus in women, which will be important later on.
As a woman, it’s integral to have a full functioning pelvic floor after birth. Things like incontinence, diastasis rectus abdominis, and pelvic organ prolapse are common issues women face daily after giving birth. Most women end up just hoping their bodies healed up back to normal, but usually that’s not the case. With these issues in mind, I always educate all my female clients how IMPORTANT it is to find a pelvic floor physiotherapist in their area.
How Should I Strengthen it?
Your doctor’s recommendation of just doing Kegel’s to strengthen your core after birth won’t cut it, and most likely won’t put you back anywhere near where you were before with your body.
As a coach, I feel responsible for giving my clients the best care I can. If that means starting a conversation with my female clients about pelvic floor dysfunction, that’s fine by me, and they all end up appreciating that I’m looking out for them. I feel like there isn’t enough information out there in the world to help those women who deal with pelvic floor dysfunction after birth and just accept the fact that the way they are feeling is just “normal.”
No, it’s not.
You can have pelvic floor dysfunction even years after giving birth to your children. It doesn’t just go away. I look at it this way. If you injure your shoulder and never end up to see a therapist to fix it, there will be issues that pop up down the road. Periodically your shoulder flares up, you can’t bench press, or shoulder press in the gym, you just work around it and maybe even at home you can’t reach for a glass on the top shelf. This scenario can go on forever until you see a physiotherapist or chiropractor to help you fix that sloppy shoulder. Same goes for a pelvic floor. The longer you wait, the longer it will stick around with reoccurring issues.
I always suggest to my female clients that if you have given birth right away book your appointment to a pelvic floor physiotherapist and simply have the assessment done to see what’s going on. For those women who are pregnant the 8–10 week mark after birth is a good time to go and have your assessment done.
What Does a Pelvic Floor Assessment Look Like?
A typical pelvic floor assessment is done with an ultrasound machine to test if you can contract your core efficiently and effectively. I had the opportunity to test my core and here’s a photo I snapped from my ultrasound:
The proper core activation sequence to ensure appropriate pelvic floor function is activation of the transverse adominis first, internal oblique second, and finally external oblique last. Many people think of bracing their core as hard as possible to absorb a punch, but this environment doesn’t do our core and pelvic floor any justice. Over time, bracing so vigorously will cause more issues down the road as not know how to unbrace and relax the pelvic girdle.
Over the years of following Dr. Stuart McGill’s work, it’s imperative to note that he is a fan of bracing to protect the integrity of the low back. From the pelvic floor world, they are advocates of “relaxing” and not bracing the core. I fall right into the middle of the equation. I like coaching how to brace and relax during core exercises to get the best of both worlds, especially with core rehab exercises like the bird dog.
Learning how to “relax” the core is also essential as many women and even men live in a world of constant bracing and can’t stop. This continuous bracing tends to lead to low back pain and SI joint discomfort when performing specific exercises and everyday chores like cleaning your house. Implementing simple relaxing exercises such as breathing can help. Check out this video here:
In the video, you’ll notice the hand position that Dr. Sarah is holding. One hand on her belly, the other on her chest. The goal of this exercise is to breathe into your bottom hand where your belly is and not into your chest. Majority of everyday people are chest breathers. They have a difficult time trying to breathe through their diaphragm, and when asked to do so they have to think about it. What this disconnection of the brain and body means is your diaphragm is “turned off” because just like the majority of people in this world who work at a desk for 8–10 hours a day crush their diaphragm and it’s difficult to breathe correctly in that position.
If you look at the anatomy of where the diaphragm sits and what you surround it’ll quickly realize how integral it is to learn how to relax your core.
If you look at the above diagram, you’ll notice that the diaphragm has two tendons that attach to the spine right around T-12. The hip flexors aka psoas inserts right around the same area of the diaphragm making these two integral to a breathing relationship. Along with this, the diaphragm has a ligament that wraps around the hip flexors and fascial webbing that’s covered all over the place. With all of these connections, if you focus on something as simple as breathing exercises with your diaphragm, and release some neural tension and tightness, those hip flexors will have less tension on them and can release tension on the low back.
Many clients of mine who suffer from chronic low back pain follow a pattern of disordered breathing, and when I prescribe some breathing exercises, after a while the tension of their low backs disappear.
Here are some breathing exercises that I prescribe to clients as part of their postpartum rehabilitation:
I think of the pelvic floor as a safety net or the first line of defence when it comes to human performance and daily activity. When our first line of defence crumbles, we end up losing the war. I want you and my clients to be victorious when it comes to physical activity, and the first step is to find the weak links, and usually, the weaknesses are not that easy to find or are as straightforward as you think.
Having a well functioning pelvic floor will not only improve quality of life but also help in the gym setting. Now, many world-class power lifters are speaking about their pelvic floors and how it acts as a “safety belt” when they are lifting heavy.
Our pelvic floor is integral to everything we do, and we should take some time to ensure it’s function.